Psychiatric Evaluation Of Sweetwater Home Board And Care

31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.

Advance Directives by the patient designates no feeding tubes, artificial ventilation, or CPR. Concerns regarding alteration of mental status consequential to his illness provoke the physician to seek consultation from the designated Power of Attorney. Nursing responsibilities compel the nurse to consider if the proposed actions of Dr. G violate the patient’s rights of self determination and confidentiality and prompt the nurse to advocate for the patient’s desires regarding medical treatment. Health care providers have a responsibility to honor the patient’s autonomy and provide quality medical care (Badger, 2009 p122). Providing artificial nutrition and ventilation transgresses the patient’s directives and is unethical. The physician appears to be asserting a paternalistic approach in deciding what is best for this patient. Should the interventions be temporary and provide resolution of the condition, the physician can defend his actions as being healing and beneficial. However, there is a chance that the interventions may be permanent and futile; avoiding passive euthanasia and terminal dehydration, serving only to prolonging the illness. Violating the patient’s directives of care by performing invasive procedures can lead to legal incriminations of assault and battery.

Clinical Assessment=According to our book, the term Clinical assessment generally refers to applying assessment procedures to (a) diagnose a mental disorder, (b) develop a plan of intervention, (c)monitor progress in counseling, and (d) evaluate counseling outcome. (Drummond, 2010). Clinical assessment has been the method used when diagnosing and planning treatment for a patient. The first step is evaluating the individual in order to obtain information and figure out what is wrong. Counselors, conduct this assessment to develop and adhere a plan of intervention, monitor clients progress, and ensue all information are interpreted and understood.

Psych: The patient states that she is depressed due to “falling apart” and anxious about dying. Denies suicidal thoughts, memory loss and confusion.

Mr. Estroga beginning receiving home health services about 2 years ago due to a wound in his foot. Shortly after Mr. Estoga lost his toes, and both his legs were amputated. Rebecca was able to treat and care for the wound. Mr. Estroga is now utilizing skilled nursing services to help with his medication management. According to Rebecca, Mr. Estroga is incapable of giving medications, giving insulin shots and filling syringes. Mr. Estroga does now have pre filled insulin shots, but he does require help from Mrs. Estroga to properly give the shots.

MT has build rapport with the client to help him with stress management strategies and coping skills. The client is currently staying with another family member for the summer and through this change of environment has allow the client to accept the treatment and work on bettering himself as the client has had no behavior incident since being discharge from Dover Behavioral Health to his other family member house. The client’s MT will continue to provide the client resources to help him control his emotion and express himself to others, which would provide help when he moves back with his guardian. In addition, the MT will assist the client’s guardian in improving communication with

The Sarah self-referred for assessment at am outpatient clinic. She subsequently requested a referral to a psychologist in Chicago, IL. Sarah is a 24-year-old adult Caucasian female who identified as a lesbian. She reported a history of depressive symptoms that have worsened in the last few months. She is seeking treatment for these intensified depressive symptoms. She described having “depression” many years ago, but became evasive when asked to clarify. In addition, she noted a concern with experiencing anger and hostility towards others; she stated that these emotions are “uncomfortable” for her. She clarified that in the past three months she has perceived herself as “grumpier than usual.” She reported having experienced anhedonia, fatigue, and insomnia.

It is “a sudden loss of function resulting from disruption of the blood supply to a part of a brain” (Hincle & Cheever, 2014). The type of stroke Patient S experienced was assumed to be from hyperlipidemia. An atherosclerotic plaque can form in the large blood vessels in the brain. When the plaque become big enough, it can rupture or a small bit may break off and flow into small arteries, which may block the smaller artery. If the artery is occluded, blood cannot flow to certain parts of the brain and an ischemic stroke can occur. Hypertension is a major risk for strokes as well as atrial fibrillation. These diseases increase the risk of an emboli or plaque

Setting the Stage: Patient 1 is an 87 year old retired man who arrived by ambulance. His last admittance to the hospital (from the nursing home that he lived at) was 2 months ago. According to his medical records, he had a history of peripheral arterial occlusive disease and deep vein thrombosis, and came in due to leg pain and a urinary tract infection. While the patient did not have a diagnosed neurocognitive disorder, the patient appeared delusional, and told the occupational therapist that he (the patient) was a retired occupational therapist, but had told the physical therapist the previous day that he was a carpenter. The patient was being treated for depression and anxiety with medications.

She denied having any difficulty with activities of daily living and did not have any problems with memory, concentration, understanding and following directions, completing tasks, or getting along with people. She did not help with house chores. She stated that did not sleep well, took her medication, watched television, played videogames, and “do nothing at home.”

Mr. Z is a 45-year-old male who demonstrates symptoms of bipolar disorder and major depressive disorder. In the last two years, he was admitted twice to psychiatric hospitals to be treated for depression and suicidal tendencies. In both of these occasions, Mr. Z argued that he did not suffer from a psychiatric illness, but that he was dying due to a strange disease of aging. However, not one of those who seen Mr. Z could diagnose what the disease was. His wife mentioned to mental health professionals that weeks prior to his admission, he would not get out of bed and was severely, “gloomy and pessimistic.” He refused to get out of bed to go to work or to spend time with his family. Mr. Z’s wife also mentioned that throughout their years of

Patient reports that five months ago she got angry with her children and stayed in bed for two days. She was feeling suicidal, mad at herself and mad at her children for not caring enough to come and get her. Patient stated that she was unsure how to leave the bedroom. This incident began this depression episode.

By the symptoms that were able to be presented, what is the best way to approach his delusions. Is it ok to go along with delusions or challenge them? Is there recovery for severe mental illness, and what does that look like for him?

He presented with chest pain and was admitted as a case of unstable angina. A nuclear stress test was done and showed small antero-septal ischemia and Moderate inferior wall ischemia. LHC done showed 90% ostium stenosis of the Left main artery, Coronary artery bypass graft was done with a left side drain in place. He was transferred to the Coronary care unit. 24hrs after surgery patient initially had tachycardia in 120s as well as shortness of breath and then started to complain of decreased vision which progressed to only

The patient is an educated professional who appears to lack knowledge of how to best utilize resources to maximize his and his family’s life